No job, no bill: Physicians tell how they help longtime patients struggling during recession

The six-physician ob-gyn practice of K. Anthony Shibley, MD, noticed an unusual scheduling pattern. Whenever a corporate layoff was announced, a surge of patients suddenly wanted to move up appointments or schedule them before their insurance ran out.

The suburban Minneapolis practice decided it wanted to assure patients that it wouldn't abandon them in their time of need. So it is letting all 10,000 of them know that if they are laid off and lose their insurance, they can get one free preventive visit and one Pap smear per year until they get another job and insurance.

Experts say such a move is a way to engender patient loyalty, because when the economy gets better, those patients will remember how you treated them when times were tough. Also, experts say the money lost in offering free preventive care to the unemployed is likely to be far less than the costs these patients might run up -- and be unable to pay -- if they wait to see you only if they are very sick.

Whatever you do, you want to communicate this sentiment to your patients: "We're all in this together."

That's the word from Arvind Goyal, MD, MPH, a solo family physician in Rolling Meadows, Ill. Since the 1980s, he has offered free visits to his established patients from the time they lose one job until they land another. Dr. Goyal said he lost some income, but the rewards offset any loss.

"When you practice medicine, sometimes the reward of doing a good job is money, sometimes it is just the internal satisfaction," Dr. Goyal said. "With these patients, you get back more in terms of loyalty. I've had some patients come and lobby with me in Springfield [at the Illinois state Capitol] on malpractice issues."

Dr. Shibley said his group is offering the free care to current unemployed patients because it tells patients the practice is a big believer in prevention, both to keep patients healthy and to keep health costs down.

"We wanted to put meaning behind our words and really be partners in their preventive care during this economic crisis," Dr. Shibley said. "The patients appreciate this and will keep coming here once they get back into their groove."

Setting parameters

Experts and physicians who offer free care advise that you inform all your patients of the program. It's one way to build up goodwill for the practice. Dr. Shibley's practice, for example, sent e-mails to patients and keeps fliers about the program in the office.

Aside from getting the word out, discretion is key. Patients receiving free care should be integrated into your schedule just as any other patient. Discretion doesn't end in the exam room. Marks made next to the free patients' names alert Dr. Shibley's front desk staff to not ask for money or an insurance card.

But experts say physicians also need to set clear limits. Any free-care policy should spell out who is eligible, the nature of the care available for free and what is the patient's responsibility to pay. Dr. Shibley's practice requires that patients bring in proof of lost insurance.

"Physicians need to understand they cannot get overwhelmed with free patients to the point it prevents access to other patients and hurts them financially," said Frederick Wenzel, PhD, professor of medical practice management at the University of St. Thomas in Minneapolis. "A couple patients aren't that big a deal, but if there is a nearby plant closing and word gets around of your offer, you might need to ration care."

That hasn't been necessary for Dr. Shibley. He said only a handful of patients have used the benefit so far. Dr. Goyal said he saw about five people for free in the last six months.

"Some take me up on my offer. Some are too proud," Dr. Goyal said. "I just know I have not become poor because of the offer."

Neither Dr. Shibley nor Dr. Goyal have any intention of capping the number of patients who will be seen for free.

Other alternatives

Experts say there are other ways physicians can help unemployed patients, such as payment plans and assistance in getting them get state aid or Medicaid. In Florida, uninsured patients can negotiate rates for treatment, similar to how insurers operate.

Dr. Goyal also tries to ease unemployed patients' financial pain by giving them sample medication or switching them to generics. He refers those who need medical care beyond what he can provide to one of the nearby free clinics or a hospital that does charity work.

Albert Puerini, MD, and about 40 other family physicians in their 170-doctor practice near Providence, R.I., have taken a different path. They provide care for some patients when a local free clinic is overflowing.

Dr. Puerini said the clinic had been asking area doctors to help relieve them of the growing crowd of patients, who were being seen on a lottery system. He said he wanted to help but couldn't get away from the office for the several hours it would take to go to the clinic in South Providence. Now he sees about five free clinic patients with chronic conditions a month at his office.

"They become my patient. They are part of my roster, and they are scheduled and treated the same as any other patient," Dr. Puerini said.

Dr. Shibley said his practice is committed to providing the free visit and exam through 2009. He and his partners will assess the program at the end of the year to determine if it will be continued.